Infection with human immunodeficiency virus (HIV) can be devastating news to newly diagnosed patients. Early recognition of the infection, monitoring of the immune deficiency both clinically and quantitatively, prophylaxis and treatment of opportunistic infections, and starting antiretroviral treatment have made such infection a chronic disease with documented increase in survival rate. More than 34 million people worldwide, and more than one million in the United States are living with HIV infection. Primary care physicians need to be familiar with the history, clinical presentation, complications, early detection, and treatment of HIV infection, especially during the early stages of the infection, when they are expected to care for these patients. US Preventive Services Task Force (USPSTF) made a Grade A recommendation to screen all patients (18 to 65 years) for HIV. If implemented, primary care physicians will care for a growing population of newly identified relatively asymptomatic HIV patients, and they will need to adhere to the latest recommendations for early treatment and prevention of transmission.

HIV clinical presentation

Patients can present with different complaints ranging from an acute nonspecific retroviral syndrome (mononucleosis like) lasting 1 to 4 weeks after HIV-1/HIV-2 acquisition with an incubation period as long as 6 weeks, to an AIDS-defining illness suggesting advanced immunosuppression, most commonly Pneumocystis jirovecii (carinii) pneumonia, esophageal candidiasis, wasting syndrome, or Kaposis's sarcoma. During this initial presentation, it is important for clinicians to establish the route and risks for acquisition of HIV with open, nonjudgmental questions because this is essential for potentially reducing further transmission and recognizing complications.